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Two cases of acute methanol poisoning partially treated by oral 4-methylpyrazole
P Hantson1, P Wallemacq, M Brau
1Department of Intensive Care, Cliniques Universitaires St-Luc, Brussels, Belgium. hantson@rean.ucl.ac.be
Objective:
Since the use of 4-methylpyrazole (4-MP) in the treatment of humans with methanol poisoning is poorly documented, we report two cases of acute methanol intoxication partially treated by this potent alcohol dehydrogenase (ADH) inhibitor.
Setting:
Intensive Care Unit in a university hospital.
Patients:
A 56-year-old man and an 18-year-old woman were observed, respectively, 41 and 16 h after the voluntary ingestion of an unknown amount of methanol.
Intervention:
In both cases, ethanol was used as the first antidote. In the first patient, hemodialysis was also performed on admission because a high methanol level (0.72 g/l) and visual impairment were noted. In the second patient, ethanol therapy was withdrawn after 12 h when clinical and biological signs of acute pancreatitis became evident. Both patients received multiple oral doses of 4-MP. No recurrence of metabolic acidosis occurred and the 4-MP therapy was well tolerated.
Conclusion:
While the use of 4-MP is better documented in cases of ethylene glycol poisoning, it could also become an accepted option for the management of methanol poisoning since 4-MP offers advantages over ethanol therapy.
Insights
4-methylpyrazole (4-MP) effectively treated methanol poisoning in two patients, showing promise as an alternative to ethanol therapy. This alcohol dehydrogenase inhibitor was well-tolerated and prevented acidosis recurrence.
Area of Science:
- Toxicology
- Pharmacology
Background:
- Methanol poisoning is a life-threatening condition requiring prompt medical intervention.
- The use of 4-methylpyrazole (4-MP), an alcohol dehydrogenase (ADH) inhibitor, in human methanol poisoning is not well-documented.
Observation:
- Two cases of acute methanol intoxication are presented.
- Patients were treated with ethanol initially, with one also undergoing hemodialysis due to high methanol levels and visual impairment.
- The second patient's ethanol therapy was discontinued due to pancreatitis; both patients then received oral 4-MP.
Findings:
- 4-methylpyrazole (4-MP) therapy was well-tolerated in both patients.
- No recurrence of metabolic acidosis was observed after 4-MP administration.
- 4-MP demonstrated efficacy in managing methanol intoxication.
Implications:
- 4-methylpyrazole (4-MP) may be a viable and advantageous alternative to ethanol for treating methanol poisoning.
- Further research into 4-MP for methanol intoxication is warranted.
- This study contributes to the understanding of 4-MP's role in managing toxic alcohol ingestions.